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Report calls for plan to survey surgical centers

A federal report requested by Congresswoman Shelley Berkley in the wake of the 2008 hepatitis outbreak in Southern Nevada recommends that the Department of Health and Human Services develop and implement a plan to conduct recurring, periodic national surveys of randomly selected ambulatory surgical centers.

That data collection effort, according to the report released Friday by the Government Accountability Office, will help focus the energy of federal agencies on ways to reduce infection and patient risk.

"The report being released highlights just how little we know about the prevalence of unsafe practices in outpatient care settings," Berkley, D-Nev., said in a statement released Friday. "While guidelines and standards exist, we lack the mechanisms to ensure they are being followed as required."

Although the GAO notes that health care associated infections are one of the top 10 leading causes of death in the United States -- the federal Centers for Disease Control and Prevention estimates 99,000 such deaths occur each year in hospitals -- the report acknowledges that authorities do not have an idea of how many Americans are put at risk of contracting infections because of unsafe infection control practices at ambulatory surgical centers.

In February of last year, health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center's Shadow Lane clinic reusing syringes in a manner that contaminated vials of medication and, officials think, infected patients.

A total of nine cases have been linked to two clinics owned by Dr. Dipak Desai, and health officials have listed an additional 105 cases as "possibly related."

As a result of the outbreak, more than 50,000 people were told to get tested for hepatitis and HIV, the virus that causes AIDS.

In 2007 alone, more than 6 million surgeries were performed in more than 5,100 ambulatory surgical centers nationwide, according to the GAO report.

The GAO suggests that because patients are generally in ambulatory surgical centers for a short time -- any infections patients acquire don't surface until they are home -- it is best to collect data on how well centers implement CDC recommended infection control practices rather than trying to collect data on where patients got their infections.

"If a complication develops following a procedure, patients often seek follow-up care from their primary care physician, a hospital emergency department or an urgent care center," making it difficult to gain reliable data about the source of an infection, the report states.

Data on whether infection control practices are being followed "can be collected more easily and can provide critical information on why health care associated infections are occurring and what can be done to help prevent them," the report says.

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